Healthcare Provider Details

I. General information

NPI: 1972684629
Provider Name (Legal Business Name): MUSNITANANDVAZQUEZLTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 E CHARLESTON BLVD
LAS VEGAS NV
89104-5525
US

IV. Provider business mailing address

4550 E CHARLESTON BLVD
LAS VEGAS NV
89104-5525
US

V. Phone/Fax

Practice location:
  • Phone: 702-459-5500
  • Fax: 702-938-6962
Mailing address:
  • Phone: 702-459-5500
  • Fax: 702-938-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: FERDINAND L TAN
Title or Position: PRESIDENT
Credential: MD
Phone: 702-459-5500